Provider Demographics
NPI:1932726726
Name:CAMPISE, GLORIA GONZALEZ (LM (LICENCED MIDWI)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:GONZALEZ
Last Name:CAMPISE
Suffix:
Gender:F
Credentials:LM (LICENCED MIDWI
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:ENRIQUETA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 553
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482
Mailing Address - Country:US
Mailing Address - Phone:707-391-7508
Mailing Address - Fax:
Practice Address - Street 1:205 W. CLAY STREET
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482
Practice Address - Country:US
Practice Address - Phone:707-621-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM612176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty